Chronic vulvovaginal skin symptoms can have debilitating effects on the quality of life of postmenopausal women. Conspicuously absent in the study of vulvovaginal skin symptoms in older women is a validated instrument to measure these symptoms, disease specific quality of life, and response to treatment. Neither the impact of these multiple etiologies on vulvovaginal skin symptoms, nor the treatments of these conditions has been established in this understudied older population. The overall objective of the proposed work is to develop an instrument to quantify vulvovaginal skin symptoms in postmenopausal women and establish the prevalence of these symptoms in community-dwelling older women presenting for routine gynecologic care. Specific Aim #1 To conduct confirmatory factor analysis on the 25 preliminary questions on vulvovaginal skin symptoms to establish an instrument to study vulvovaginal skin symptoms, the Vulvovaginal Skin Symptom Questionnaire (VSSQ), in postmenopausal women. To date, we have developed a 25-item questionnaire on vulvovaginal skin symptoms, adapted from a validated questionnaire for patients with contact dermatitis, and administered this questionnaire to 120 postmenopausal women seeking routine gynecologic care. The preliminary VSSQ items have demonstrated the psychometric properties of construct validity, test-retest reliability, and internal consistency. Confirmatory factor analysis is the next step in demonstrating the psychometric properties of this instrument. Specific Aim #2 To estimate the associations of self management practices and vulvar contact irritant exposure among postmenopausal women with and without vulvovaginal skin symptoms. To date, we have developed and administered a uniform question set on self management practices, hormonal therapy usage, and vulvar contact irritant exposure to 120 women. We hypothesize that women with vulvovaginal skin symptoms will have increased vulvar contact irritant exposure compared with women without symptoms. Specific Aim #3 To establish the prevalence of vulvovaginal skin symptoms in postmenopausal women utilizing the VSSQ and further characterize the association incontinence-related vulvar skin damage with these symptoms. After establishing the finalized VSSQ instrument, we will recruit a cohort of 300 postmenopausal women seeking routine gynecologic care to establish the prevalence of vulvovaginal skin symptoms and further characterize these symptoms in postmenopausal women. We hypothesize that postmenopausal women with vulvovaginal skin symptoms will have increased urinary and fecal incontinence compared with women without symptoms. The expected outcome of the proposed work is a validated instrument to study vulvovaginal skin symptoms and a better understanding of these symptoms in postmenopausal women.